Doc fix new weapon vs. health reform

Congressional Republicans are hoping to put Democrats in a no-win new year's jam: defund a big chunk of their health care overhaul or slash Medicare payments instead.

Despite rampant repeal rhetoric, Republicans have so far struggled to dismantle any part of health reform. Now, they see a new path forward: pilfer health reform dollars to pay for the next "doc fix," the must-pass patch to Medicare doctor payments.

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Republican Senate aides familiar with the issue told POLITICO they are seriously looking at the new law's $15 billion public health commitment to finance a one-year doc fix in the next session of Congress.

The Senate has passed four doc fixes this year alone, none of which were longer than six months and two lasted just 30 days. The last patch, a one-month reprieve passed by the House on Monday, will expire on Dec. 31. Without a doc fix, Medicare provider rates would drop 25 percent.

The idea of tying the doc fix to a partial health reform repeal has legs because it comes with a clear rhetorical message: Congress should not start creating new entitlements without the necessary funding to uphold existing ones.

Sen. Orrin Hatch (R-Utah), who will serve as ranking member on the Finance Committee next session, would not comment on specific budgeting but he did indicate that the committee would not move forward with a doc fix that was not fully funded.

"Ensuring that Medicare reimbursement rates aren't slashed is important, but so too is making sure that we stop adding to our already sky-high deficit," Hatch told POLITICO in a statement. "Over the next month, I'll be working with my colleagues to accomplish a longer-term fix that's paid for and doesn't add to the deficit."

The prospect of Republicans yanking reform funds puts major pressure on the Democrats to come up with a yearlong patch before the lame-duck session ends. But so far, Democrats have been unable to find the necessary $19 billion in offsets to finance a yearlong fix.

One aide said health reform's preventive health spending is one of the "top three" offsets in the law that congressional Republican staffers are eyeing, with the idea that a few moderate Democrats facing tough races in 2012 could eventually be brought on board.

As for which part of the health reform law to pull funds from, Republicans have long derided the multibillion Prevention and Public Health Fund as wasteful spending, scoffing at its investment in bike paths and farmers' markets. One Republican Senate aide quipped that it was a "slush fund for jungle gyms."